Correspondence  |   December 2016
Pure Science or Purely Biased
Author Notes
  • Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
  • (Accepted for publication August 17, 2016.)
    (Accepted for publication August 17, 2016.)×
Article Information
Correspondence   |   December 2016
Pure Science or Purely Biased
Anesthesiology 12 2016, Vol.125, 1246. doi:10.1097/ALN.0000000000001368
Anesthesiology 12 2016, Vol.125, 1246. doi:10.1097/ALN.0000000000001368
The carefully crafted study “Auscultation versus Point-of-care Ultrasound to Determine Endotracheal versus Bronchial Intubation”1  was performed with great care to blind the observers. The ultrasound technique is described in detail, but the auscultation technique is unmentioned. Because the authors report that the “screens of the anesthesia machine and general monitor were partially covered to conceal the peak and mean airway pressure readings, capnography waveform, and the pulse oximetry (SpO2) values,” we may deduce that auscultation was performed during mechanical ventilation, presumably using current recommendations of tidal volumes of 5 to 7 ml/kg and positive end-expiratory pressure. The proper technique for auscultating for endotracheal tube placement requires placement of the stethoscope in the axilla and rapidly inflating the lungs with a larger than normal tidal volume to maximize breath sounds. Failure to utilize such a technique places auscultation at a distinct disadvantage in the comparison. An appropriate comparison for an ultrasound examination might be performing it with the gain minimized or the display turned to minimal intensity. Is it scientifically rigorous to compare two devices when the technique applied to one seriously hinders its application?
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